小细胞肺癌与非小细胞肺癌放疗诱发放射性肺炎的临床特点分析

Clinical characteristics analysis of radiation pneumoniain small cell lung cancer and non-small cell lung cancer

目的比较小细胞肺癌(SCLC)和非小细胞肺癌(NSCLC)患者在接受胸部放疗后发生的放射性肺炎(RP)是否存在差异,为医生的临床抉择和患者的精确治疗提供依据。方法回顾性分析2016-01-01-2016-12-31甘肃省肿瘤医院放疗科收治的94例接受放射治疗的Ⅲ-Ⅳ期SCLC(n=41)和NSCLC(n=53)患者的临床资料。给予患者三维适形放疗或调强放疗,比较SCLC和NSCLC患者发生RP的不同特点,包括患者在治疗期间至发生RP的C反应蛋白(CRP)的变化,治疗过程中发生病原微生物感染对RP发生的影响,V5、V10、V15、V20、V60和平均肺剂量(MLD)与RP的关系。结果94例患者中,16例(17.02%)SCLC患者发生RP,16例(17.02%)NSCLC患者发生RP,差异无统计学意义,P=0.370。2级RP 13例(SCLC患者8例,NSCLC患者5例),3级RP 19例(SCLC患者8例,NSCLC患者11例),无4、5级RP发生,不同分级的RP在SCLC和NSCLC之间差异无统计学意义,P=0.218。RP与患者性别、TNM分期、年龄等因素无关,P>0.05;RP发生与照射总剂量、GTV体积、放疗剂量学参数(V5、V10、V15、V20、V60、MLD)等均无关,均P>0.05;RP的发生与同步放化疗(χ2=9.309,P=0.002)、同步化疗的周期数有关(χ2=9.352,P=0.009)。RP发生前、后的CRP差异无统计学意义,P>0.05;在同步放化疗期间发生的微生物感染(细菌、真菌)差异有统计学意义,P=0.027。结论SCLC和NSCLC患者中,RP的发生与同步化疗及其周期数有关,并与治疗期间微生物感染存在一定关系。

OBJECTIVE To comparative analyse difference of radiation pneumonia(RP)after patients received thoracic radiotherapy in small cell lung cancer(SCLC)and non-small cell lung cancer(NSCLC),and provide evidence for clinical accurate treatment.METHODS The clinical data of 94patients with stageⅢ-ⅣSCLC(n=41)and NSCLC(n=53)who underwent radiotherapy were retrospectively analyzed from 2016-01-01to 2016-12-31.To compare the different characteristics of RP in patients with SCLC and NSCLC who were received three-dimensional conformal radiotherapy or intensity-modulated radiotherapy,including changes in C-reactive protein(CRP),pathogenic microorganisms and V5,V10,V15,V20,V60and mean lung dose(MLD)in the period of the beginning of treatment to the onset of RP.RESULTS Of the 94patients,RP(17.02%)occurred in 16patients with SCLC,and RP(17.02%)occurred in 16patients with NSCLC.The difference was not statistically significant(P=0.370).Grade 2RP was 13(8patients with SCLC,5patients with NSCLC),and 19patients with grade 3RP(8patients with SCLC and 11patients with NSCLC),but no grade 4or 5RP occurred.The difference was not statistically significant in different grades of RP between SCLC and NSCLC(P=0.218).RP was not associated with gender,TNM stage,age(P>0.05);RP occurred regardless of total radiation dose,GTV volume,radiotherapy dosimetry parameters(V5,V10,V15,V20,V60,MLD),P>0.05.Although,the RP was related to the number of cycles of concurrent chemoradiotherapy(χ2=9.309,P=0.002)and concurrent chemotherapy(χ2=9.352,P=0.009).There was no significant difference in CRP between before and after RP(P>0.05).There was a statistically significant difference in microbial infection(bacteria and fungi)during concurrent chemoradiotherapy(P=0.027).CONCLUSION In the patients with SCLC and NSCLC,concurrent chemotherapy is associated with RP and the number of cycles of concurrent chemotherapy is related to RP;and there is a relationship with microbial infection with RP during treatment.